Autism, Brain, and Environment

Chapter 2
Autism and Autism Spectrum
Disorders: An Introduction
to the Problem of Recognition
and Diagnosis

Autism is difficult to describe, though trained clinicians say it is as distinctive as a
sunset or a symphony. Some disorders are easily defined by markers, such as the
extra chromosome found in Down syndrome. Others can be ascertained by
numerical values: for example, of blood pressure in the assessment of hypertension, or of blood sugar in diabetes. No essential markers have yet been identified
in autism, and none may exist. Instead the criteria for autism are now widely
accepted to involve anomalies in three central categories, known as the triad of
impairments, as set out by Wing and Gould:1

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deficits or marked abnormalities in social interaction

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deficits or marked abnormalities in communication including
language

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restricted and often repetitive behavioral repertoires, interests, and
activities.

Of course, many childhood problems meet one or more of these criteria, and the
experienced physician relies on other clues to venture a precise diagnosis of
autism rather than another disorder. For instance, an unusual enjoyment of
spinning objects, flapping movements of the hands, an intriguing fixation on the
sense of smell – with newcomers being greeted with a sniff rather than a [hello] are all seen in autism. But these features are difficult to quantify. And, though

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